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The Cochrane Database of Systematic... Jan 2020Low vision rehabilitation aims to optimise the use of residual vision after severe vision loss, but also aims to teach skills in order to improve visual functioning in... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Low vision rehabilitation aims to optimise the use of residual vision after severe vision loss, but also aims to teach skills in order to improve visual functioning in daily life. Other aims include helping people to adapt to permanent vision loss and improving psychosocial functioning. These skills promote independence and active participation in society. Low vision rehabilitation should ultimately improve quality of life (QOL) for people who have visual impairment.
OBJECTIVES
To assess the effectiveness of low vision rehabilitation interventions on health-related QOL (HRQOL), vision-related QOL (VRQOL) or visual functioning and other closely related patient-reported outcomes in visually impaired adults.
SEARCH METHODS
We searched relevant electronic databases and trials registers up to 18 September 2019.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) investigating HRQOL, VRQOL and related outcomes of adults, with an irreversible visual impairment (World Health Organization criteria). We included studies that compared rehabilitation interventions with active or inactive control.
DATA COLLECTION AND ANALYSIS
We used standard methods expected by Cochrane. We assessed the certainty of the evidence using the GRADE approach.
MAIN RESULTS
We included 44 studies (73 reports) conducted in North America, Australia, Europe and Asia. Considering the clinical diversity of low vision rehabilitation interventions, the studies were categorised into four groups of related intervention types (and by comparator): (1) psychological therapies and/or group programmes, (2) methods of enhancing vision, (3) multidisciplinary rehabilitation programmes, (4) other programmes. Comparators were no care or waiting list as an inactive control group, usual care or other active control group. Participants included in the reported studies were mainly older adults with visual impairment or blindness, often as a result of age-related macular degeneration (AMD). Study settings were often hospitals or low vision rehabilitation services. Effects were measured at the short-term (six months or less) in most studies. Not all studies reported on funding, but those who did were supported by public or non-profit funders (N = 31), except for two studies. Compared to inactive comparators, we found very low-certainty evidence of no beneficial effects on HRQOL that was imprecisely estimated for psychological therapies and/or group programmes (SMD 0.26, 95% CI -0.28 to 0.80; participants = 183; studies = 1) and an imprecise estimate suggesting little or no effect of multidisciplinary rehabilitation programmes (SMD -0.08, 95% CI -0.37 to 0.21; participants = 183; studies = 2; I = 0%); no data were available for methods of enhancing vision or other programmes. Regarding VRQOL, we found low- or very low-certainty evidence of imprecisely estimated benefit with psychological therapies and/or group programmes (SMD -0.23, 95% CI -0.53 to 0.08; studies = 2; I = 24%) and methods of enhancing vision (SMD -0.19, 95% CI -0.54 to 0.15; participants = 262; studies = 5; I = 34%). Two studies using multidisciplinary rehabilitation programmes showed beneficial but inconsistent results, of which one study, which was at low risk of bias and used intensive rehabilitation, recorded a very large and significant effect (SMD: -1.64, 95% CI -2.05 to -1.24), and the other a small and uncertain effect (SMD -0.42, 95%: -0.90 to 0.07). Compared to active comparators, we found very low-certainty evidence of small or no beneficial effects on HRQOL that were imprecisely estimated with psychological therapies and/or group programmes including no difference (SMD -0.09, 95% CI -0.39 to 0.20; participants = 600; studies = 4; I = 67%). We also found very low-certainty evidence of small or no beneficial effects with methods of enhancing vision, that were imprecisely estimated (SMD -0.09, 95% CI -0.28 to 0.09; participants = 443; studies = 2; I = 0%) and multidisciplinary rehabilitation programmes (SMD -0.10, 95% CI -0.31 to 0.12; participants = 375; studies = 2; I = 0%). Concerning VRQOL, low-certainty evidence of small or no beneficial effects that were imprecisely estimated, was found with psychological therapies and/or group programmes (SMD -0.11, 95% CI -0.24 to 0.01; participants = 1245; studies = 7; I = 19%) and moderate-certainty evidence of small effects with methods of enhancing vision (SMD -0.24, 95% CI -0.40 to -0.08; participants = 660; studies = 7; I = 16%). No additional benefit was found with multidisciplinary rehabilitation programmes (SMD 0.01, 95% CI -0.18 to 0.20; participants = 464; studies = 3; I = 0%; low-certainty evidence). Among secondary outcomes, very low-certainty evidence of a significant and large, but imprecisely estimated benefit on self-efficacy or self-esteem was found for psychological therapies and/or group programmes versus waiting list or no care (SMD -0.85, 95% CI -1.48 to -0.22; participants = 456; studies = 5; I = 91%). In addition, very low-certainty evidence of a significant and large estimated benefit on depression was found for psychological therapies and/or group programmes versus waiting list or no care (SMD -1.23, 95% CI -2.18 to -0.28; participants = 456; studies = 5; I = 94%), and moderate-certainty evidence of a small benefit versus usual care (SMD -0.14, 95% CI -0.25 to -0.04; participants = 1334; studies = 9; I = 0%). ln the few studies in which (serious) adverse events were reported, these seemed unrelated to low vision rehabilitation.
AUTHORS' CONCLUSIONS
In this Cochrane Review, no evidence of benefit was found of diverse types of low vision rehabilitation interventions on HRQOL. We found low- and moderate-certainty evidence, respectively, of a small benefit on VRQOL in studies comparing psychological therapies or methods for enhancing vision with active comparators. The type of rehabilitation varied among studies, even within intervention groups, but benefits were detected even if compared to active control groups. Studies were conducted on adults with visual impairment mainly of older age, living in high-income countries and often having AMD. Most of the included studies on low vision rehabilitation had a short follow-up, Despite these limitations, the consistent direction of the effects in this review towards benefit justifies further research activities of better methodological quality including longer maintenance effects and costs of several types of low vision rehabilitation. Research on the working mechanisms of components of rehabilitation interventions in different settings, including low-income countries, is also needed.
Topics: Depression; Humans; Quality of Life; Randomized Controlled Trials as Topic; Self Efficacy; Vision, Low
PubMed: 31985055
DOI: 10.1002/14651858.CD006543.pub2 -
Turkish Journal of Ophthalmology Jun 2019With increased life expectancy at birth and especially the rising incidence of age-related macular degeneration, low vision (re)habilitation is becoming more important... (Review)
Review
With increased life expectancy at birth and especially the rising incidence of age-related macular degeneration, low vision (re)habilitation is becoming more important today. Important factors to consider when presenting rehabilitation and treatment options to patients presenting to low vision centers include the diagnosis of the underlying disease, the patient’s age, their existing visual functions (especially distance and near visual acuity), whether visual loss is central or peripheral, whether their disease is progressive or not, the patient’s education level, and their expectations from us. Low vision patients must be guided to the right centers at the appropriate age, with appropriate indications, and with realistic expectations, and the rehabilitation process must be carried out as a multidisciplinary collaboration.
Topics: Humans; Ophthalmology; Vision, Low; Visual Acuity
PubMed: 31245978
DOI: 10.4274/tjo.galenos.2018.53325 -
Ophthalmology. Glaucoma 2019
Topics: Disease Management; Glaucoma; Global Health; Humans; Morbidity; Vision, Low; Visual Acuity
PubMed: 32672580
DOI: 10.1016/j.ogla.2019.01.012 -
Indian Journal of Ophthalmology Jan 2021To identify children with low vision from two local schools for the blind, to provide low vision devices (LVD) to those who may benefit from it, and to encourage them to... (Review)
Review
PURPOSE
To identify children with low vision from two local schools for the blind, to provide low vision devices (LVD) to those who may benefit from it, and to encourage them to learn print.
METHODS
A prospective study was conducted among children from two local schools for the blind. Best-corrected visual acuity (BCVA) was done using the Snellen chart. Children with BCVA of counting finger (CF) 1/2 meter or more in the better eye underwent low vision assessment. Distant vision was assessed using the Feinbloom chart and near vision was assessed using the Lea symbol chart. Low vision devices (LVD) were prescribed as required.
RESULTS
Among 185 children enrolled, 31 children had BCVA of >CF ½ meter. Using a telescope, distant vision was better than 3/36 in 48.4%, 3/36-3/12 in 16.2%, and 3/9.5 to 3/3 in 35.4%. Among 23 children who read 1M at <10 cm, 22.6% could read 0.6-0.8M, and 25.8% could read 1M using LVD.
CONCLUSION
Regular screening of children in schools for the blind could identify children who might benefit from LVD. A review of protocols for the entry of children in schools for the blind by screening these children by a specialist team prior to admission should be made mandatory.
Topics: Child; Humans; India; Prospective Studies; Schools; Vision Screening; Vision, Low; Visual Acuity
PubMed: 33323596
DOI: 10.4103/ijo.IJO_142_20 -
Annual Review of Vision Science Oct 2016Low vision is any type of visual impairment that affects activities of daily living. In the context of low vision, we define plasticity as changes in brain or perceptual... (Review)
Review
Low vision is any type of visual impairment that affects activities of daily living. In the context of low vision, we define plasticity as changes in brain or perceptual behavior that follow the onset of visual impairment and that are not directly due to the underlying pathology. An important goal of low-vision research is to determine how plasticity affects visual performance of everyday activities. In this review, we consider the levels of the visual system at which plasticity occurs, the impact of age and visual experience on plasticity, and whether plastic changes are spontaneous or require explicit training. We also discuss how plasticity may affect low-vision rehabilitation. Developments in retinal imaging, noninvasive brain imaging, and eye tracking have supplemented traditional clinical and psychophysical methods for assessing how the visual system adapts to visual impairment. Findings from contemporary research are providing tools to guide people with low vision in adopting appropriate rehabilitation strategies.
Topics: Contrast Sensitivity; Humans; Neuronal Plasticity; Optical Imaging; Vision, Low; Visual Acuity; Visual Fields; Visual Perception
PubMed: 28532346
DOI: 10.1146/annurev-vision-111815-114344 -
Restorative Neurology and Neuroscience 2019
Topics: Humans; Nerve Regeneration; Vision, Low; Visual Field Tests
PubMed: 31839617
DOI: 10.3233/RNN-199001 -
Journal of Ophthalmic Nursing &... 19981. The ophthalmologist and staff are ultimately responsible for identifying low vision patients. 2. Most low vision patients who have a professional low vision... (Review)
Review
1. The ophthalmologist and staff are ultimately responsible for identifying low vision patients. 2. Most low vision patients who have a professional low vision evaluation are able to use vision enhancing devices. 3. In addition to optical magnifyers, new computer and television technology enhances use of residual vision.
Topics: Communication Aids for Disabled; Eyeglasses; Humans; Nursing Assessment; Referral and Consultation; Vision, Low
PubMed: 10095528
DOI: No ID Found -
Optometry and Vision Science : Official... Apr 2021This article summarizes the evidence for a higher prevalence of binocular vision dysfunctions in individuals with vision impairment. Assessment for and identification of... (Review)
Review
This article summarizes the evidence for a higher prevalence of binocular vision dysfunctions in individuals with vision impairment. Assessment for and identification of binocular vision dysfunctions can detect individuals experiencing difficulties in activities including reading, object placement tasks, and mobility.Comprehensive vision assessment in low vision populations is necessary to identify the extent of remaining vision and to enable directed rehabilitation efforts. In patients with vision impairment, little attention is typically paid to assessments of binocular vision, including ocular vergence, stereopsis, and binocular summation characteristics. In addition, binocular measurements of threshold automated visual fields are not routinely performed in clinical practice, leading to an incomplete understanding of individuals' binocular visual field and may affect rehabilitation outcomes.First, this review summarizes the prevalence of dysfunctions in ocular vergence, stereopsis, and binocular summation characteristics across a variety of ocular pathologies causing vision impairment. Second, this review examines the links between clinical measurements of binocular visual functions and outcome measures including quality of life and performance in functional tasks. There is an increased prevalence of dysfunctions in ocular alignment, stereopsis, and binocular summation across low vision cohorts compared with those with normal vision. The identification of binocular vision dysfunctions during routine low vision assessments is especially important in patients experiencing difficulties in activities of daily living, including but not limited to reading, object placement tasks, and mobility. However, further research is required to determine whether addressing the identified deficits in binocular vision in low vision rehabilitative efforts directly impacts patient outcomes.
Topics: Activities of Daily Living; Depth Perception; Humans; Quality of Life; Reading; Vision, Binocular; Vision, Low; Visual Fields; Visual Perception; Visually Impaired Persons
PubMed: 33828038
DOI: 10.1097/OPX.0000000000001672 -
Canadian Journal of Ophthalmology.... Apr 2016The State of the Art is strong - to paraphrase another famous saying. Low vision rehabilitation (LVR) is today a recognized discipline in Ophthalmology, expanding and... (Review)
Review
The State of the Art is strong - to paraphrase another famous saying. Low vision rehabilitation (LVR) is today a recognized discipline in Ophthalmology, expanding and improving the quality of life of numerous visually impaired patients. It was not so about a century ago when it all started. Then, charity work aimed at helping blind children was all that LVR was. With advances in science, medicine and public health policy, help for the blind expanded its reach to all who were visually impaired. Devices and re-training of skills have been added to complement diagnosis and charity work. Modern LVR, which took hold in the last few decades, was propelled to new heights by relentless advances in basic and clinical sciences. Today we can provide significant and meaningful help to visually impaired patients in most situations. It could be as simple as a hand magnifier or as intricate as a retinal prosthesis. In many instances it seems to be just a beginning for things still to come.
Topics: Diagnostic Techniques, Ophthalmological; Humans; Sensory Aids; Vision, Low; Visually Impaired Persons
PubMed: 27085259
DOI: 10.1016/j.jcjo.2015.11.002 -
Canadian Journal of Ophthalmology.... Jun 2014
Review
Topics: Adolescent; Child; Child, Preschool; Humans; Infant; Quality of Life; Vision, Low; Visually Impaired Persons
PubMed: 24862788
DOI: 10.1016/j.jcjo.2014.03.011